Provider Demographics
NPI:1356788608
Name:BROWN, GEORGE JR (DMD, MSD)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:
Last Name:BROWN
Suffix:JR
Gender:M
Credentials:DMD, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 GEORGIAN PARK
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PEACHTREE CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30269-6973
Mailing Address - Country:US
Mailing Address - Phone:770-631-2728
Mailing Address - Fax:770-631-2714
Practice Address - Street 1:1401 GEORGIAN PARK
Practice Address - Street 2:SUITE 100
Practice Address - City:PEACHTREE CITY
Practice Address - State:GA
Practice Address - Zip Code:30269-6973
Practice Address - Country:US
Practice Address - Phone:770-631-2728
Practice Address - Fax:770-631-2714
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-28
Last Update Date:2013-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0128921223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics